tbuckley/cabot-search huggingface dataset:
Abstract 13900: Combined Use of Venoarterial Extracorporeal Menbrane Oxygenation and Impella Improves the Outcome in Patients With Cardiogenic Shock
Authors: Tomoko Nakayama, Takashi Unoki, Motoko Kametani, Yuta Tsurusaki, Takaaki Toyohuku, Junya Matsuura, Satoko Hasegawa, Yutaka Konami, Hiroto Suzuyama, Kazuhisa Kodama, Tetsuo Yufu, Megumi Yamamuro, Eiji Taguchi, Tadashi Sawamura, KOICHI NAKAO, Tomohiro Sakamoto
Journal: Circulation (2022)

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides benefit to patients in refractory cardiac arrest and cardiogenic shock. However, VA-ECMO elevates LV afterload and causes pulmonary edema and LV distension. Additional IABP support has been recommended in Japan to reduce LV afterload. Alternatively, transcatheter left ventricular assist device, Impella has been recently introduced. However, it remains to be evaluated if there is clinical benefit of concomitant use of VA-ECMO and Impella (ECPELLA). Methods: Aim of this single-site cohort study is to assess the effects of ECPELLA as compared with ECMO with IABP in patients who were managed with VA-ECMO due to refractory cardiogenic shock including cardiac arrest. Results: We retrospectively reviewed 253 consecutive patients, who received VA-ECMO from January 2012 to May 2022 in our institute. Among them, 67 patients who were managed with VA-ECMO alone were excluded. Patients were divided into two groups, ECEPLLA (n=68) and ECMO with IABP (n=118). We applied propensity score analysis with 1:1 score matching using dependent variables of age, the rate of sex, acute coronary syndrome, out-of-hospital and in-hospital cardiac arrest, and extracorporeal cardio-pulmonary resuscitation. We assessed 30-day survival rate, hemodynamic data, and safety profiles including acute kidney injury, blood transfusion and embolic cerebral infarction. Results: Following propensity score matching, 60 ECPELLA and 60 ECMO with IABP patients were included for analysis. The 30-day survival was significantly higher with ECPELLA group compared with ECMO with IABP group (ECPELLA: 48% vs. ECMO with IABP: 28%, p= 0.01, log-rank test). There were no statistical differences in ECMO weaning rate and safety profiles between treatment groups. Conclusions: ECPELLA may be associated with improved 30-day survival in patients with refractory cardiac shock including cardiac arrest.
Abstract 13531: Hydrogen Sulfide Donor, SG1002, Protects Against Hypertension-Induced Exacerbation of Doxorubicin Cardiotoxicity in Female Mice
Authors: Adolfo G Mauro, Donatas Kraskauskas, Emma Noyelle, Malk Eldessouky, Giselle C Melendez, Edward Lesnefsky, Stefano Toldo, William G Hundley, Fadi N Salloum
Journal: Circulation (2022)

Background: Dose-dependent declines in left ventricular ejection fraction (LVEF) and increases in heart failure (HF) limit the administration of doxorubicin [DOX] in the treatment of breast cancer, lymphoma, and leukemia. Cancer patients with hypertension (HTN) experience higher rates of developing HF after DOX and perhaps share mechanistic contributors (e.g., oxidative stress and inflammation) to LVEF declines. Hydrogen sulfide (H 2 S) has been shown to stimulate mitochondrial stability and reduce the residual inflammatory risk in the setting of myocardial infarction. Hypothesis: The orally active, slow-releasing H 2 S donor SG1002 attenuates DOX-induced LVEF decline and cardiotoxicity in mice with HTN. Methods: Adult female C57BL mice were randomized to either control diet or SG1002-enriched chow to achieve a dosage of 40 mg/kg/day for the duration of the study. Mice underwent osmotic minipump implantation to deliver angiotensin II (ATII) (1500ng·kg -1 ·min -1 ; N=7/group) for 28 days to cause HTN. Seven days following ATII infusion initiation, DOX was delivered i.p., 4 doses of 5 mg/kg every 3 days (cumulative dose: 20mg/kg). Mice underwent tail-cuff blood pressure measurement and echocardiography at baseline, 12 days (post 2 nd DOX dose) and 28 days post initiation of ATII infusion (Fig A). Results: Twenty-eight-day measures in LVEF were lower in HTN animals receiving DOX relative to those without HTN. SG1002-fed mice demonstrated preserved LVEF following DOX (Fig B). Additionally, SG1002-fed mice exhibited an attenuated hypertensive phenotype following ATII infusion (Fig C). Conclusion: Our results in female mice indicate that HTN worsens DOX-induced cardiomyopathy, which is attenuated with SG1002 treatment. Interestingly, SG1002 also prevented HTN following ATII infusion in female mice. Further studies are warranted to determine the efficacy of the H 2 S donor, SG1002 to prevent DOX-associated LVEF declines in mice with and without HTN.
Abstract 14250: Interpretation of Pediatric Cardiopulmonary Exercise Testing: Impact of Socioeconomic Status
Authors: Maanasi Mistry, Naomi Gauthier, Mark E Alexander, Kimberlee Gauvreau, Kathy J Jenkins
Journal: Circulation (2022)

Introduction: Peak oxygen consumption (pVO 2 ) is a marker of cardiovascular fitness. While anthropometric data are incorporated into predictive equations, like the Cooper equation, social determinants of health are not. We hypothesized that socioeconomic status (SES) has a greater effect than standard demographic values on predicted pVO 2 in a contemporary population. Methods: This is a retrospective analysis of maximal cardiopulmonary exercise test (CPET) data from 2010 to 2020 for largely healthy patients age &lt;19 years with BMI percentile (BMI%) between 5-95. Data were sorted by self-identified race, BMI%, and adjusted gross income (AGI) based on IRS zip code data; AGI was used as a surrogate for SES. Mean percent predicted pVO 2 (%ppVO 2 ) was compared between groups for each variable. Linear regression was used to adjust for differences. Results: A total of 541 CPETs met inclusion criteria. Mean %ppVO 2 was 97% ± 22.6 predicted (p&lt;0.001) with 30% below criterion standard for normal (85% predicted). After excluding unknown AGI and race, 418 CPETs remained. Mean %ppVO 2 was lower for blacks (n=36) and LatinX (n=26) compared to whites (n=333, p=0.007). Mean %ppVO 2 significantly declined as AGI decreased (p&lt;0.001). The differences in %ppVO 2 between racial categories compared to white remained significant when adjusted for BMI% (black r=-7.3, p=0.035; LatinX r=-15.4, p=0.001). However, these differences both decreased in magnitude and were no longer significant when adjusted for AGI (black r=-6.0, p=0.150; LatinX r=-9.3, p=0.055). Conclusions: Lower SES correlates negatively with measured cardiovascular fitness and may confound data interpretation. When using normative reference ranges in clinical decision making, providers should recognize that social determinants of health, rather than patient-related factors, may be more related to predicted fitness. Attention should be paid to social inequities when assessing pediatric cardiovascular fitness.
Abstract 13525: The Mitraclip System Improves Cardiovascular Outcomes Compared to Medical Management in the Setting of Cardiogenic Shock
Authors: Caleb Chiang, Mina Kerolos, Joseph Eid, Ethan Ritz, Laith Derbas, Tisha Suboc, Fareed M Collado, Clifford J Kavinsky, Hussam S Suradi
Journal: Circulation (2022)

Introduction: Cardiogenic shock (CS) is associated with high mortality and morbidity. Severe mitral regurgitation (MR) in the setting of CS is associated with poor outcomes. Transcatheter Edge-to-Edge Repair (TEER) with the Mitraclip system is commonly used to treat MR, though its use in CS is less defined. Hypothesis: TEER with Mitraclip in patients with moderate to severe MR and CS improves cardiovascular outcomes compared to medical management alone. Methods: A single-center, retrospective study included adult patients with moderate to severe MR and CS between 2012 and 2021. Moderate to severe MR was defined by grades 3+ and 4+ MR. CS was defined as a sustained systolic blood pressure &lt;90mmHg for at least 1 hour, use of inotropes, vasopressors, or mechanical circulatory support, and clinical and laboratory findings of end-organ damage. The primary outcome was major adverse cardiovascular events (MACE) defined as cardiovascular death, heart failure admission, stroke, and myocardial infarction at 30 days and 6 months. The secondary outcome was change in New York Heart Association (NYHA) classification. Results: There were 28 patients included in the medical management and 33 in the Mitraclip groups. Table 1 includes this study’s outcomes. There were no significant differences in patients with a MACE at 30 days (13 vs. 8, p=0.069), though there were significant differences at 6 months (12 vs. 7, p=0.002). There were no differences in cardiovascular death. Patients in the Mitraclip group had fewer heart failure admissions at 6 months (p=&lt;0.001), though not at 30 days. At 30 days, more patients in the Mitraclip group improved to NYHA classes I/II compared to medical management alone (10 [35.7%] vs. 16 [50%], p=0.043). There were no differences in NYHA classes I/II at 6 months (7 [43.7%] vs. 13 [54.2%], p=0.63). Conclusions: TEER using the Mitraclip system improves mid-term cardiovascular outcomes in patients with CS compared to medical management alone.
Abstract 12880: Left Ventricular Mass Predicts Cardiac Reverse Remodeling in Patients With Type 2 Diabetes and Coronary Artery Disease Who Are Treated With Empagliflozin
Authors: Pankaj Puar, Makoto Hibino, Hwee Teoh, Adrian Quan, Raj Verma, David Mazer, Andrew Yan, Kim Connelly, Subodh Verma
Journal: Circulation (2022)

Introduction: Left ventricular (LV) hypertrophy is associated with an elevated risk for cardiovascular disease and all-cause mortality. The cardiovascular benefits of sodium-glucose cotransporter protein-2 (SGLT2) inhibitors have been attributed, in part, to cardiac reverse remodeling. The EMPA-HEART CardioLink-6 study previously reported that SGLT2 inhibition with empagliflozin for 6 months was associated with a significant reduction in LV mass indexed to body surface area (LVMi). We sought to determine in the same cohort if baseline LVMi influences empagliflozin-associated cardiac reverse remodelling. Methods: A total of 97 patients with type 2 diabetes and coronary artery disease was randomized to empagliflozin (10 mg/d) or matching placebo for 6 months in the EMPA-HEART CardioLink-6 study. This cohort was stratified into those with baseline LVMi &lt;60 g/m 2 and those with LVMI ≥60 g/m 2 . Between-group comparisons were conducted using a linear regression model adjusted for baseline differences in LVMi (ANCOVA) that included an interaction term between baseline LVMi sub-group and treatment. Results: The effect empagliflozin had on the change in LVMi over 6 months was significantly different between patients with a baseline LVMi &lt;60 g/m 2 and those whose LVMi was ≥60 g/m 2 . The adjusted difference between those randomized to empagliflozin and those assigned placebo after multivariable adjustment for baseline characteristics was 0.59 g/m 2 (95% CI: -3.01 g/m 2 , 4.19 g/m 2 , P=0.74) and -7.03 g/m 2 (95% CI: -11.06 g/m 2 , -2.99 g/m 2 , P=0.001) in the LVMi &lt;60 g/m 2 and LVMi ≥60 g/m 2 subgroups, respectively (P interaction =0.0054). No significant association was found between baseline LVMi and 6-month change in LV end systolic volume-indexed (P interaction =0.086), LV end diastolic volume-indexed (P interaction =0.34), or LV ejection fraction (P interaction =0.15). Conclusions: In the EMPA-HEART CardioLink-6 cohort, greater cardiac reverse remodelling benefits were observed with empagliflozin in patients with higher baseline LVMi. Studies with larger cohorts and longer follow-ups are warranted to confirm the impact baseline LV mass has on SGLT2 inhibitor-associated remodelling.
Abstract 13384: Choice of Antihypertensive Agent in Isolated Systolic Hypertension and Isolated Diastolic Hypertension: A Secondary Analysis of the Allhat Trial
Authors: Stephen Y Wang, Jonathan M Hanna, Prajesh Gongal, Oyere Onuma, Michael Nanna
Journal: Circulation (2022)

Introduction: Although isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) exhibit differing pathophysiology and phenotypes, it is unclear whether specific antihypertensive agents are preferred for each condition. Methods: Using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), we set out to determine whether certain antihypertensive agents had differential effects on clinical outcomes in patients with ISH or IDH. We defined ISH as SBP ≥140mmHg and DBP &lt;90mmHg, and we defined IDH as SBP &lt;140mmHg and DBP ≥90mmHg. We used risk-adjusted cox regression to evaluate the primary outcome (a composite of all-cause mortality, combined CHD, or stroke) by antihypertensive agent in cohorts of patients with ISH or IDH. We also evaluated achievement of normotension using risk-adjusted logistic regression. Results: We identified 12,845 patients with ISH and 1,259 patients with IDH. The adjusted hazard of the primary outcome was similar across antihypertensive agents for both ISH (aHR=1.01, 95% CI 0.94-1.09 for amlodipine vs chlorthalidone, and aHR=1.03, 95% CI 0.95-1.10 for lisinopril vs chlorthalidone) and IDH (aHR=1.06, 95% CI 0.80-1.41 for amlodipine vs chlorthalidone, and aHR=1.11, 95% CI 0.84-1.47 for lisinopril vs chlorthalidone) (Figure). There were no significant differences across antihypertensive agents in the achievement of normotension at six years for ISH (OR=1.01, 95% CI 0.89-1.15 for amlodipine vs chlorthalidone; and OR=0.97, 95% CI 0.85-1.10 for lisinopril vs chlorthalidone) or IDH (aOR=0.92, 95% CI 0.59-1.42 for amlodipine vs chlorthalidone; and aOR=0.77, 95% CI 0.49-1.21 for lisinopril vs chlorthalidone). Conclusions: In this large cohort of patients, clinical events were similar across antihypertensive agents for both ISH or IDH. These results lend credence to the flexible treatment recommendations in current hypertension guidelines.
Abstract 14273: Obesity Paradox and Its Impact on Heart Failure With Preserved Ejection Fraction (HFpEF) in Geriatric Patients: A 2019 National Inpatient Analysis
Authors: Harshit Narula, Monika Singh, Shabnam Abrishami, Mariam Aqeel, Rabiya Niaz, Siva Naga S Yarrarapu, Memoona Saeed, Ashwini Mahadevaiah, Anjani Kumar Thota, Rupak Desai
Journal: Circulation (2022)

Introduction: Several studies have shown obesity to be inversely associated with mortality, the so-called obesity paradox. Although being a major cardiovascular risk factor, patients with morbid obesity are often excluded in HFpEF-related trials. Thus, we aim to evaluate the impact of obesity on major adverse cardiovascular and cerebrovascular events (MACCE) in Hospitalized Geriatric Patients with HFpEF. Methods: We queried the National Inpatient Sample (2019) to identify the geriatric admissions (age ≥65 years) with HFpEF. Comorbidities and outcomes were compared between obese and non-obese patients using relevant ICD-10 codes. Adjusted odds and independent predictors of MACCE with obesity were assessed by multivariable regression controlling for confounders. Results: Of 1743940 geriatric admissions with HFpEF, 430395 (24.7%) were obese [median age 75[70-80], female 63.1%, white 77.1%]. The obese cohort often consisted of relatively younger, female, black patients and had higher rates of obstructive sleep apnea (34.1% vs. 10.9%), diabetes (50.3% vs. 31.3%), hyperlipidemia (62.9% vs. 56.6%), chronic lung disease (48.2% vs 38.4%) and depression (17.3% vs. 13.4%) than non-obese (p&lt;0.001). Comorbidities including hypertension (OR 2.00), peripheral vascular disease (OR 1.19), chronic kidney disease(OR 1.19) (p&lt;0.001), and metastatic cancer (OR 1.20; p&lt;0.019) were independent predictors for MACCE. The obese cohort had significantly lower adjusted odds (OR 0.82) of MACCE (Obesity Paradox) and all-cause mortality (2.9% vs. 4.6%) (p&lt;0.001). They were more frequently discharged with prolonged hospital stays and higher hospital charges compared to non-obese (p&lt;0.001). Conclusions: Obese geriatric HFpEF admissions have significantly lower odds of all-cause mortality and MACCE but higher comorbidity burden and healthcare utilization as compared to non-obese. Hypertension, metastatic cancer, CKD, and PVD were independent risk factors of MACCE.
Abstract 13783: Near-Real Time Extended Ambulatory ECG Monitoring in Patients With Syncope Unveils a Spectrum of Arrhythmias and High Incidence of Atrial Fibrillation
Authors: Bobbi L Hoppe, Matthew Reynolds, Mike Hsu, Lori Crosson, Alan Wilk, marie-noelle langan
Journal: Circulation (2022)

Introduction: Patients (pts) with a history of syncope are at high risk for sudden death with a reported 1-year mortality rate of 30%. Triaging relevant arrhythmias (ars) in a timely manner in this population is critical to allow for potential life-saving interventions. For example screening atrial fibrillation (AF) studies of pts with no known AF, reported an AF detection of 4.5% to 5.3%. It is unknown if these findings extend to a syncope population. A recent syncope study reported most significant ars occurred outside the typical window of a hospital stay. Therefore, this study aims to analyze a proprietary Zio AT database containing arrhythmia findings of pts monitored for the diagnosis of syncope. Methods: Data retrospectively analyzed 10,643 pts from US institutions with a syncope indication for monitoring. Pts with recordings between July 2017 to December 2021 were analyzed. All ars transmitted via cellular gateway during the wear period and full ECG download at end of wear were analyzed with a validated proprietary AI algorithm, then followed by a certified cardiographic technician review. Ars were defined as: AF, ≥30 seconds at any heart rate; SVT, ≥90 bpm for ≥4 S beats; Pause, ≥3 second; AV Block, any 3rd or 2nd degree AV Block (Mobitz I or II); VT, ≥100 bpm for ≥4 V beats or PVT, TdP, VF. Detected ars were characterized by duration, episode counts, rates, and/or burden (where applicable). Results: Of the 10,643 pts studied (49% female, mean age 65.4 years, mean wear 11.9 ± 3.6 days), 8,442 (79%) had at least 1 arrhythmia detected, with 3,107 (29%) having 2 or more arrhythmia types. Most common ars detected in this patient population were SVT (69%; 7365/10643), VT (26%; 2716/10643), and AF (9.5%; 1015/10643). AV Blocks (3.6%; 382/10643) and Pauses (6.2%; 662/10643) were not uncommon. Surprisingly, the most common arrhythmia to trigger a notification alert was AF/AFL (8.5%). Average time until first AF detection was 1.4 ± 2.8 days for all AF subjects and 2.8 ± 3.5 days for paroxysmal AF subjects. Conclusions: In this large retrospective study, ambulatory ECG monitoring with ZIO AT in syncope indicated pts revealed an unexpectedly high incidence of AF and SVT. Further analysis of this group may help clinicians focus a heightened awareness of atrial ars in this population.
Abstract 13280: Proteomic Indicators of Cardiovascular Health Relate to Brain Volume and Dementia Risk
Authors: Heather E Dark, Clare Paterson, Zhongsheng Peng, Michael R Duggan, Gulzar N Daya, Murat Bilgel, Yang An, Abhay Moghekar, Christos Davatzikos, Susan Resnick, Kelsey Loupy, Missy Simpson, Thomas Mosley, Josef Coresh, Stephen A Williams, Keenan A Walker
Journal: Circulation (2022)

Introduction: Several studies demonstrate that cardiovascular (CV) health - even among individuals without overt CV disease - is associated with brain function and may influence Alzheimer’s disease (AD) and dementia progression. Using a proteomic score to quantify the full spectrum of CV health, the current study examined the association of protein-based indicators of CV risk and CV-related mortality with brain structure and dementia risk among older adults. Methods: The SomaScan platform was used for plasma proteomic phenotyping in the Baltimore Longitudinal Study of Aging (BLSA) (n=984) and the Atherosclerosis Risk in Communities (ARIC) study (n=7901). SomaSignal Test measures of risk for CV events, and heart failure-related mortality were derived from the proteome. Concurrent with blood-draw for proteomic assessments, BLSA participants received 3T brain MRI scans, which quantified AD-relevant brain atrophy (SPARE-AD) and total brain volume (TBV). Following protein measurement at Visit 3, ARIC participants were followed for 20+ years, during which time incident dementia was assessed. We used demographic-, intracranial volume, and APOE ε4-adjusted linear regression and Cox models to relate proteomic indicators of CV health to brain volume and dementia risk, respectively. Results: Protein-based risk for CV events and heart-failure mortality were each associated with greater brain atrophy in regions vulnerable to AD and lower total brain volume ( Figure 1 ). Higher risk scores for CV events and both preserved and reduced ejection fraction heart failure mortality were associated with incident dementia (HR per z-score increase (95% CI): 1.26 (1.20-1.33), 1.18 (1.12-1.23) and 1.27 (1.22-1.32), respectively, all p &lt; 0.001). Conclusions: Proteomic indicators of risk for CV disease/mortality are associated with neurodegeneration and future dementia risk. Proteomic indicators of CV health may aid in monitoring and prediction of neurodegenerative disease.
Abstract 14874: Electrical Isolation of the Posterior Left Atrium is Associated With a Lower Incidence of Atrial Tachycardia in Patients With Persistent Atrial Fibrillation
Authors: Andrew Chou, Krit Jongnarangsin, Miki Yokokawa, Michael Ghannam, Jackson Liang, Hakan Oral, Fred Morady, Aman Chugh
Journal: Circulation (2022)

Introduction: Patients may develop atrial tachycardia (AT) after left atrial (LA) ablation of persistent atrial fibrillation (AF). Hypothesis: We hypothesized that patients with persistent AF undergoing electrical isolation of the posterior wall of the LA would be less likely to experience AT, and specifically, roof-dependent tachycardia as compared to historical controls who only received linear ablation at the LA roof. Methods: The population consisted of 101 consecutive patients (age= 64.3±8.7 years, 70 males (69%), LA=4.6±0.8 cm, ejection fraction=48.5±16%) undergoing their initial procedure for persistent AF. After pulmonary vein isolation, patients either underwent posterior LA isolation (n=50; study group) or linear ablation at the LA roof with verification of conduction block by established pacing maneuvers (n=51; control group) Results: During the initial procedure for AF, electrical isolation of the posterior LA or linear block at the LA roof were achieved in all patients in the study or control groups, respectively. During follow-up, patients in the study group were less likely to develop AT (9/50 [18%] vs. 18/51 [35%]; p=0.02), roof-dependent (1/50 [2%] vs. 8/51 [16%]; p=0.008), and multi-loop AT (6/50 [12%] vs. 14/51 [27%]; p=0.03) as compared to controls. A repeat procedure was performed in 18 (34%) and 28 (55%) patients in the study and control groups, respectively (p=0.03). After a mean follow-up of 25.3 ± 13, and 50.3 ± 27.3 months, 45 of the 50 study (90%), and 44 of the 51 control patients (86%) remained in sinus rhythm (p=0.72), with 12 and 13 patients taking antiarrhythmic medications, respectively (p=0.43) Conclusions: In patients with persistent AF, posterior LA isolation is associated with a lower risk of a redo procedure, roof-dependent macro-reentry, and post-ablation AT in general as compared to controls who only received linear ablation of the left atrial roof. Posterior LA isolation also obviates pacing maneuvers, the results of which might be equivocal, and may be a more definitive endpoint of linear ablation at the LA roof